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TN Gyneco > 18. Urogynecology > Flashcards

18. Urogynecology Flashcards

1
Q

Identify parts

A
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2
Q

Identify

A

Rectocele

A rectocele is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina.

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3
Q

Identify

A

Cystocele

A cystocele is when the wall between the bladder and the vagina weakens. This can cause the bladder to drop or sag into the vagina.

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4
Q

Identify

A

Uterine Prolapse

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina.

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5
Q

Identify

A

Enterocele

Enterocele is the descending of the small intestine into the lower pelvic cavity.

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6
Q

Define: Pelvic Relaxation/Prolapse (1)

A

Protrusion of pelvic organs into or out of the vagina

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7
Q

Describe etiology of prolapse (1)

A

relaxation, weakness, or defect in the cardinal and uterosacral ligaments which normally maintain the uterus in an anteflexed position and prevent it from descending through the urogenital diaphragm (i.e. levator ani muscles)

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8
Q

Prolapse is related to what? (8)

A
  • vaginal childbirth
  • aging
  • decreased estrogen (post-menopause)
  • following pelvic surgery
  • increased intra-abdominal pressure (obesity, chronic cough, constipation, ascites, heavy lifting)
  • congenital (rarely)
  • ethnicity (Caucasian women > Asian or African women)
  • collagen disorders
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9
Q

Describe general conservative treatment of prolapse (3)

A

(for pelvic relaxation/prolapse and urinary incontinence)

  • Kegel exercises
  • local vaginal estrogen therapy
  • vaginal pessary (intravaginal suspension disc)
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10
Q

Describe: Grading of Pelvic Organ Prolapse (6)

A
  • 0 = no descent during straining
  • 1 = distal portion of prolapse >1 cm above level of hymen
  • 2 = distal portion of prolapse ≤ 1 cm above or below level of hymen
  • 3 = distal portion of prolapse > 1cm below level of hymen but without complete vaginal eversion
  • 4 = complete eversion of total length of lower genital tract
  • Procidentia : failure of genital supports and complete protrusion of uterus through the vagina
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11
Q

Define: Cystocele (1)

A

protrusion of bladder into the anterior vaginal wall

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12
Q

Describe clinical features: Cystocele (3)

A
  • Frequency, urgency, nocturia
  • Stress incontinence
  • Incomplete bladder emptying ± associated increased incidence of UTIs (may lead to renal impairment)
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13
Q

Describe tx: Cystocele (3)

A
  • General conservative tx
  • Anterior colporrhaphy (“anterior repair”)
  • Consider additional/alternative surgical procedure if documented urinary stress incontinence
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14
Q

Define: Enterocele (1)

A

prolapse of small bowel in upper posterior vaginal wall

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15
Q

Describe tx: Enterocele (2)

A
  • Similar to hernia repair
  • Contents reduced, neck of peritoneal sac ligated, uterosacral ligaments, and levator ani muscles approximated
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16
Q

Define: Rectocele (1)

A

protrusion of rectum into posterior vaginal wall)

17
Q

Describe clinical features: Rectocele (2)

A
  • Straining/digitation to evacuate stool
  • Constipation
18
Q

Describe tx: Rectocele (3)

A
  • General conservative tx
  • Also laxatives and stool softeners
  • Posterior colporrhaphy (“posterior repair”), plication of endopelvic fascia and perineal muscles approximated in midline to support rectum and perineum (can result in dyspareunia)
19
Q

Define: Uterine Prolapse (1)

A

protrusion of cervix and uterus into vagina

20
Q

Describe clinical features: Uterine Prolapse (7)

A
  • Groin/back pain (stretching of uterosacral ligaments)
  • Feeling of heaviness/pressure in the pelvis
  • Worse with standing, lifting
  • Worse at the end of the day
  • Relieved by lying down
  • Ulceration/bleeding (particularly if hypoestrogenic)
  • ± urinary incontinence
21
Q

Describe tx: Uterine Prolapse (3)

A
  • General conservative treatment
  • Vaginal hysterectomy ± surgical prevention of vault prolapse
  • Consider additional surgical procedures if urinary incontinence, cystocele, rectocele, and/or enterocele are present
22
Q

Define: Vault Prolapse (1)

A

protrusion of apex of vaginal vault into vagina, post- hysterectomy

23
Q

Describe tx: Vault Prolapse (1)

A
  • General conservative tx
  • Sacralcolpopexy (vaginal vault suspension), sacrospinous fixation, or uterosacral ligament suspension
24
Q

The only true hernia of the pelvis is what? (1)

A

an ENTEROCELE because peritoneum herniates with the small bowel

25
Q

Define: Stress incontinence (1)

A

involuntary loss of urine with increased intra-abdominal pressure (cough, laugh, sneeze, walk, run)

26
Q

Name risk factors for stress incontinence in women (9)

A
  • age
  • obesity
  • parity
  • vaginal delivery
  • pelvic prolapse
  • pelvic surgery
  • hypoestrogenicstate (post-menopause)
  • smoking
  • neurological/pulmonary disease
27
Q

Describe tx: Stress incontinence (2)

A
  • see Prolapse, GY36
  • surgical
    • tension-free vaginal tape (TVT), tension-free obturator tape (TOT), prosthetic/fascial slings or retropubic bladder suspension (Burch or Marshall-Marchetti-Krantz procedures)
28
Q

Define: Urge incontinence (3)

A
  • urine loss associated with an abrupt, sudden urge to void
  • “overactive bladder”
  • diagnosed based on symptoms
29
Q

Describe etiology: Urge incontinence (2)

A
  • idiopathic (90%)
  • detrusor muscle overactivity (“detrusor instability”)
30
Q

Name associated symptoms: Urge incontinence (4)

A
  • frequency
  • urgency
  • nocturia
  • leakage
31
Q

Describe tx : Urge incontinence (3)

A
  • behaviour modification (reduce caffeine/liquid, smoking cessation, regular voiding schedule)
  • Kegel exercises
  • medications
    • anticholinergics: oxybutinin (Ditropan®), tolterodine (Detrol®), solifenacin (VESIcare®)
    • tricyclic antidepressants: imipramine
32
Q

Name neurological causes of urge incontinence to rule out (3)

A
  • MS
  • Herniated disc
  • DM

TN Gyneco (20 decks)

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